DENTAL TRAUMATIC INJURIES

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1 DENTAL TRAUMATIC INJURIES Nitrous Oxide Not Contraindicated Predisposing Factors > 90% of All Injuries Protrusion of Anterior Teeth Poor Lip Coverage

2 Mouthguards Girls as Well as Boys Off - the - Shelf Vs. Individualized Colors Neurological Protection

3 Legal Considerations Detailed Records Standardized Forms Consistant Information Professional Responsibility

4 Medical Issues Never Treat a Stranger Neurological Assessment Above All Else, Do No Harm Inappropriate Treatments Endo in Hand Snip Root Tip Scrub Root Surface Soak in Fluoride

5 Head Injury Medical Emergency Priorities Patient before dental! Neurological Assessment Aware X 3? Loss of Consciousness? Nausea or Vomiting? P E R R L A? Drowsy? Blurred Vision? Highway Patrol...

6

7 Other Medical Issues Current Meds? Other Pathology? Tetanus Status ( DPT) 10 years...

8 Antibiotic Necessity Bacterial Endocarditis Prophylaxis Soft Tissue Through and Through Avulsion: Prevent Root Resorption Dentoalveolar Infections Later Trauma Treatment Priorities No Further Damage... Save the Tooth Save the Vitality Compromised PDL - Crush Sequellae Types of Injuries Concussion Fracture Luxation Intrusion Extrusion Avulsion Root Fracture

9 Fracture Classifications A Picture is Worth A Thousand Words Class I, II, and III

10 Locate Fragment ANYONE SEE IT? IN THE LACERATION? RADIOGRAPHIC LOCATION AVOID PROBING IF POSSIBLE

11 Endodontic Considerations Direct Pulp Cap 1 of 2 reasonable applications Mechanical (surgical) exposure Larger Exposure - Pulpotomy Primary - Formocresol Permanent - Calcium Hydroxide Partial Pulpotomy? Necrotic Complete pulpectomy Obturation Interim Permanent Apexification Permanent Dentition Ca(OH)2 GP Final

12 Radiographic Needs Periapical Views Two Required Lateral Radiograph Primary Anterior Intrusions Panorex Suspect Major Bony Fractures Subcondylar Mandibular LaFort Types

13 Concussive Sequellae Fracture Dissipates Energy Diminished Pulpal Shock Adjacent Teeth Future Prognosis Warning to Patient / Parents

14 Luxation Injuries Reposition Crossbite Potential for Root Resorption Stabilization

15 Adequate Isolation Rubber Dam no clamp premaxilla contiguous holes Cotton Rolls and Saliva Ejector Dri-Angles

16 Splints: Appropriate Use Easy to Apply Hygienic Patient can maintain Adequate Stabilization Ease of Removal for doctor for patient Splinting Times Luxations 7-10 Days Avulsions 7-10 Days Root Fractures 3 months All Are Estimates; Frequent Revision Andreasen & J of Trauma

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21 Intrusive Injuries Status of Periodontal Ligament Status of Alveolar Bone Status of Pulp Reposition??? Orthodontic Repositioning Reposition STAT Root Resorption Orthodontic Repositioning

22 Primary Versus Permanent Different Pulpal Prognosis Recovery Likelihood Dangers of Sequellae Primary Anterior Intrusion Into Follicle? Apex Through Cortical Plate? Reasonable Expectation of Re-eruption?

23 Apical Penetration of Cortical Plate Reposition? Extract? Pulpectomy...

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25 Primary Anterior Intrusions Re-eruption Probability 6-12 months = 50%? Ankylosis...Extract Stat! Pulpectomy Necessary?

26 Replantation Protocol On Site 15 Minute Window MAX! Clean Gross Debris Hold in Position Seek Dental Care If MUST Transport > Milk Contraindicated Endondontics in Hand Scrape/Scrub Root Surface Soak in 10% SnF Unless exarticulated > 1 Hour Snip Root Tip Primum Non Nocere - Galen Milk Still A Far Second Choice

27 Dental Replantation Protocol Check for Full Replantation Occlusion Stabilize Follow-up Short-term Long-term

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30 Root Resorption Replacement Ankylosis Inflammatory Disappearance of root Calcium Hydroxide Temporary Obturation

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32 Apexogenesis and Resorption Prevention Calcium Hydroxide Obturation 3-10 Day window Instrumentation and Complete Cleansing Critical Replace at 3 and 6 months If No Contradicting Signs/Symptoms - Final Fill Long Term Observation

33 Replantation Research Doxycycline soak Hank s Balanced Salt Solution Shortened or No Splint Times

34 Root Fracture Prognosis Location Dependent The More Apical the Better Long Bone Model of Repair Longer Splint Time Endodontics? Complete? Partial Coronal Fragment Long Term Observation

35 Sequellae to Trauma To the Involved Teeth External Resorption Internal Resorption Ankylosis Loss of Vitality Root Dilaceration, Canal Dystyrophic Calcification To Succedaneous Teeth Damage to Follicle Timing Critical Hypoplasias, Demineralization,etc. Root Dilaceration Loss of Tooth

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39 Replacement Options Short Term: Removable: Kiddie Partial Fixed: Orthodontic Band Retained Long Term Etch Retained Bridge FPD Eventual: Implant or FPD

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42 Childrens Hospital of New York New York Presbyterian

43 It s Over... Thank You!

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